Reading of the Week: Guest Contribution – Dr. David Goldbloom on Lithium and Self Harm

From a Contributing Editor, Colleague and Friend of the Editor

Sixty-seven years ago, Australian psychiatrist John Cade published his case series on manic patients treated with lithium – truly the dawn of the modern era in psychopharmacology. Two decades passed before lithium came to Canada, and almost three before it came to the United States. In the treatment of mania, it was the first significant drug alternative to the only other enduring treatment from that time – electroconvulsive therapy.

Dr. John Cade (and Lithium)

Today, however, lithium suffers from under-promotion (there is no money to be made on it by the pharmaceutical industry) and under-exposure in the training of residents despite the evidence of its benefit that continues to emerge.

Here is a new paper that looks at suicide and self-harm during maintenance treatment of people with bipolar disorder treated with lithium, valproate or the increasingly popular second-generation antipsychotic drugs. And here is an old paper that reminds us what a difference lithium had already made in the economics of mental illness by 1980.

– David Goldbloom, OC, MD, FRCP(C) Continue reading

Reading of the Week: Cancer and Mental Illness

From the Editor

“Now that I’m done with my [cancer] treatment, I’m struggling to figure out who I am,” writes essayist Suleika Jaouad.

This week’s Reading focuses on cancer and mental illness.

We open with a major new paper just published by JAMA Oncology (involving hundreds of thousands of cancer patients) and we then consider an essay by Suleika Jaouad talking about how cancer affected her physical and mental health.

DG Continue reading

Reading of the Week: Battling The Black Dog

From the Editor

This week, hundreds of thousands of Canadians will not go to work because of mental health problems, depression being the most common.

But despite the long shadow cast by depression on our society, it’s difficult not to feel that we fall short in terms of our active management. Many people struggle with their symptoms; even when they can beat the “black dog” – to use Winston Churchill’s term – they are at high risk for relapse.

Can we do better with the black dog?

Here are two papers that look at bettering outcomes.

In the first, the authors ask if mindfulness can prevent the relapse of depression. The second paper considers the use of statins to improve the effects of antidepressants.

DG Continue reading

Reading of the Week: The New Maunder-Hunter Book

From the Editor

Patrick is not participating in physiotherapy, and is thus not eligible for discharge. To the staff on the orthopedics ward at the hospital where I work, that’s a Big Problem.

On Tuesday afternoons, I finish at the Birchmount campus of The Scarborough Hospital and drive to the General, where I see patients on medical and surgical floors. And on a recent Tuesday, I met Patrick.

For the record, Patrick has more than one Big Problem. Patrick smokes and he drinks too much. Patrick has diabetes and lung changes. Patrick is obese. And it’s the combination of all of the above that led to the fall that left him with the fractured hip and the surgery. If Patrick is doing badly – this is his second hospitalization in fifteen months – it’s not for lack of health-care effort. Since his last discharge, he has seen an endocrinologist, his family doctor, and a respirologist. Patrick has home care. Patrick is, in other words, a heavy user of the health-care system. And if we are serious about restraining health costs in light of an aging population, we need to find better ways of dealing with people like Patrick.

This week’s Reading: an excerpt from the new Maunder-Hunter book. In it, the authors forward the following idea: people like Patrick can be better helped if we think about attachment theory.

As you will recall, attachment theory is based on experiments with children exposed to strangers. To summarize (and possibly oversimplify) some very clever experiments: after seeing the stranger, if the child seeks out the parent, and is soothed, it’s considered healthy, or secure attachment, as opposed to insecure attachments, like avoidant attachment and resistant attachment (where the child is less interested in the parent or is difficult to soothe).

This is a terrific and important book – and of interest to all clinicians.

It’s thoughtful and relevant. Do you see patients? You should get this book.

DG

Continue reading

Reading of the Week: Mental Health — Is There an App For That? & More

From the Editor

Sigmund Freud, Aaron Beck, Steve Jobs?

Do apps have the potential to reshape mental health?

It’s a hot topic and Nature – the prestigious British journal – explores the potential and pitfalls of mental health apps.

In this week’s Reading, we consider “Pocket Psychiatry.”

Also: journalist John Stossel discusses his lung cancer – and health-care delivery.

DG Continue reading

Reading of the Week: Thinking Globally and Acting Locally – Scaling Up Depression and Anxiety Treatment

From the Editor

Tim Evans doesn’t mince his words: “The situation with mental health today is like HIV-AIDS two decades ago.”

Tim Evans is a senior director at the World Bank Group. He made these comments after the release of a major new study suggesting that depression and anxiety are undertreated – and costing the world’s economy hundreds of billions of dollars a year.

But this paper has good news: an investment in mental health services will offer a return (counting health benefits) in the range of 3.3 to 5.7.

This week’s Reading: this new paper from The Lancet Psychiatry, and the reaction to it. Note that coverage has included The Guardian and The New York Times (Evans comments are from The New York Times).

I also follow up on last week’s popular Reading on the Goldbloom-Bryden book.

DG Continue reading

Reading of the Week: How Can I Help? The Goldbloom-Bryden Book

From the Editor

This week’s Reading: an excerpt from the new Goldbloom-Bryden book.

Get this book. Read it. Share it with your friends.

It’s beautifully written and important.

DG Continue reading

Our New Paper: “Making Evidence-Based Psychotherapy More Accessible in Canada”

Happy to see that our paper has just been published (online first) in The Canadian Journal of Psychiatry. And what a great project. My co-author, Dr. David Goldbloom, is a former supervisor from my training, a mentor, and a friend. Back in residency, we talked about a joint project – so glad that, after a few years, it happened.

As usual, I learned much from working with him.

You can find the paper here:

http://cpa.sagepub.com/content/early/2016/04/05/0706743716642416.full.pdf+html

Reading of the Week: Mukherjee’s Essay on Schizophrenia, Genetics, and His Uncle

From the Editor

This is a moving essay about family and loss – and the long shadow of mental illness.

It’s lengthy, but worth the time.

DG Continue reading

Reading of the Week: Big Study on a Big Problem: Stigma & Mental Health, and More

From the Editor

Stigma. Suicide prevention.

This week we consider these weighty topics with two excellent papers.

The first, written by Patten et al., looks at the perception of stigma in those receiving mental health care in Canada. The second is a “viewpoint” that asks what we need to do to reduce suicide rates – which, across the West, has not decreased in the past decade.

DG Continue reading